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Manuals, Forms, & Support

Providers contracted by Ped-I-Care to participate in Children’s Medical Services Plan (CMS Plan) are supported by various means, including provider manuals, provider directories, and training; CMS Plan Nurse Care Coordination; and the efforts of Ped-I-Care’s Provider Relations Liaisons.

What is the Role of the PRL?
Ped-I-Care’s Provider Relations Liaisons, or PRLs, are responsible for network development through provider recruitment and education. Just as importantly, they are responsible for network retention by ensuring high levels of provider satisfaction. With at least one representative in every region, issues are addressed directly and resolved quickly due to the proximity of PRLs and their commitment to provider satisfaction.

   Title 21 (CHIP) Provider Directory  

NOTICE: In-State vs. Out-of-State Providers

Because Ped-I-Care is required to follow Medicaid guidelines, in-state providers are to be used prior to seeking out of state (OOS) providers.

Please access our T19 and T21 provider directories to locate an in-state, contracted provider before submitting requests for an OOS provider.

Claims Information: MMA/Title 19

Claims Information: CHIP/Title 21

Change Healthcare/
Emdeon Electronic Payer ID: EM843
Availity Electronic Payer ID: M3FL0012Send paper claims to:
CMS Plan Title 19
PO Box 981648
El Paso, TX 79998-1648

 

Click here to check
member eligibility, claims status,
and authorizations.

Provider Manual – T19 –
February 7 2017

Change Healthcare/
Emdeon Electronic Payer ID: EM205
Availity Electronic Payer ID: M3FL0014Send paper claims to:
MED3OOO/Ped-I-Care Title 21
PO Box 981733
El Paso, TX 79998-1733

 

Click here to check
member eligibility, claims status,
and authorizations.

Provider Manual – Title 21 –
July 6 2017

Pharmacy Information

Forms & Applications

Resources & Training

* PCPs refer to in-network specialty providers for services needed by the child; specialists may also make referrals to other specialists. It is not necessary to obtain a referral number from the third-party administrator; however many specialists do require a referral or consultation request from the requesting provider. This does NOT eliminate the requirement for authorizations to be obtained for services and procedures that require a prior authorization. Information regarding these processes and forms are contained within the Utilization Management section of our provider manuals, listed above.

** Pursuant to § 383.14(1)(a) and 383.011(1)(e), F.S., this form must be completed by the health care provider for every pregnant woman and submitted to the local county health department.

*** Pursuant to § 383.14(1)(b) and 383.011(1)(e), F.S., this form must be completed for each infant and submitted to the local County Health Department, Office of Vital Statistics.

Provider Video: Finding the Florida Medicaid Fee Schedules and Handbooks

One of the most frequently asked questions at Ped-I-Care is, “Where do I find the Medicaid fee schedules and handbooks?” In this quick video, we’ll show you how to quickly, specifically navigate the AHCA website to find what you need.

Click here for the TRANSCRIPT – Where Do I Find the Florida Medicaid Handbooks and Fee Schedules.

 

Provider Video: Providing Services and Requesting Authorizations

This Ped-I-Care produced video covers the basics of requesting authorizations and using resources to ensure efficient processing of the authorization.

Click here for the TRANSCRIPT – Providing Services and Getting Paid.

 

Provider Video: Staying Compliant

This video is designed to help providers understand how to avoid common mistakes in billing and documentation. A guide to resources is also available.

Click here for the TRANSCRIPT – Staying Compliant.

 

Click here for the TRANSCRIPT – Preventing Claims Denials.